Online Application for Employment

Pennock Health Services is fully committed to Equal Employment Opportunity and to attracting, retaining, developing and promoting the most qualified employees without regard to their race, gender, color, religion, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, or any other characteristic prohibited by state or local law. We are dedicated to providing a work environment free from discrimination and harassment, and where employees are treated with respect and dignity.

Page 1 of 3 - Personal and Background Information

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Name * First Last
Phone (Mobile or Home) * - ### - ### ####
Please provide the best number for us to reach you on, whether that may be your cell phone or home phone.
Phone (Other) - ### - ### ####
Email *
Current Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
*Please note that an answer of "yes" may require further details or an explanation in the appropriate boxes.
Position Applying For:

*Please note, the EXACT title of the current job posting is required. Only ACTIVE job postings will be accepted. If you enter a generic job posting or one that is no longer active, your application will not be considered for employment. *

Please include the appropriate title of the current job your are applying for. If there is more than one specific job opening that you are interested in, we do ask for an application of employment for each position.
Salary Desired: *

Please include your salary amount desired or if applicable, your hourly amount desired.
Date Available for Work * / MM / DD YYYY
Available For: *
Full Time Part Time Occasional Temporary Internship
Please indicate your availability. You may choose more than one option if your availability is flexible.
Are you willing and able to work the following: *
Day Shift Evening Shift Night Shift Rotating Shift Holidays Weekends On Call
Please indicate your ability to work our various shift requirements. You may choose more than one option.
Are you 18 years of age or older? *
Yes No
How were you referred to Pennock Health? *
Advertisement Friend Relative Other
Do you have Relatives or Friends currently employed by Pennock Health Services? *
Yes No
If you answer yes, please give the name and relationship of the individual in the next field
If Yes, please give us the name and relationship of the individual:
Have you ever been employed by Pennock Health Services? *
Yes No
If you answer yes, please provide When? Position? and Name Used? in the following box.
If Yes, please provide details on When? | Position? | and Name Used:
Are you currently using Illegal Drugs? *
Yes No
*Current means within the last 30 days
Have you ever been convicted of a Felony or are there current Felony charges pending agaisnt you? *
Yes No
If yes, please provide further details in the next box
If Yes, please provide further explanation:
*A felony conviction does not automatically disqualify you from employment. Rather, the organization's decision will be determined on whether the conviction relates in some way to the position applied for
Do you have an Employment Obligation to any other Healthcare Institution? *
Yes No
If yes, please provide further details in the next box
If Yes, please provide further explanation:
Are you, or have you ever been disqualified from Medicaid, Medicare, or other Federal Payor Programs? *
Yes No
If yes, please provide further details in the next box
If yes, Payor Name:
Were you ever in the Military? *
Yes No
If yes, please provide details in the following boxes as required by law
If Yes, please include below your Branch, Entry Date, Discharge Date, Rank Entered, Achieved Rank, and any Special Training Received:
**If you have your Cover Letter, Resume, References, and any Special Certifications or Skills via a Document or PDF, you may upload them below to complete your application. *If you DO NOT have these documents, you are REQUIRED to complete the following fields to consider your application for employment complete and valid for consideration.
Upload Cover Letter

Attach Files
Upload Resume

Attach Files
Upload References (if not currently on your Resume)

Attach Files

Please note that Pennock Health Services does require 3 Non-Relative References to accompany all applications
Upload Certifications or Special Skills

Attach Files
Save my progress and resume later
Enter Your Email Address

A special link to resume the form will be sent to your email address.

Online Application for Employment

Online Application for Employment

Page 1 of 3 - Personal and Background Information

*Please note that an answer of "yes" may require further details or an explanation in the appropriate boxes.

*A felony conviction does not automatically disqualify you from employment. Rather, the organization's decision will be determined on whether the conviction relates in some way to the position applied for